Park could face shortage as generation of adventurous family doctors retires
By Leigh Hornbeck
Woods McCahill moved to Lake Placid in 1980, fresh out of residency. It was always his dream to work as a family physician in the Adirondacks. He grew up in Albany, where he went to medical school and drove north every chance he had to hike.
McCahill said he chose family practice over another field of medicine because it would improve his chances of getting a job in a small town. He spent eight years in private practice before joining the staff at the Adirondack Medical Center, where he has been ever since.
McCahill, now 69, was among a wave of young doctors drawn to the Adirondacks between 1975 and 1985. Med school cost $4,000 a year back then. Whatever loans the young doctors carried, the debt didn’t stand in the way of the lives the doctors wanted.
“We all skied, hiked, paddled,” McCahill said.
Times have changed. Six-figure debts point young doctors toward lucrative careers in cities.
Now some in McCahill’s generation are retiring, just as the coronavirus pandemic threatens to further strain the rural North Country’s reliance on the special breed of doctors who are willing to follow in his steps and serve isolated Adirondack communities.
For McCahill, the charm of life in the company of wilderness never wore off. Last winter he bagged more than 100 ski days. Next winter he should have even more time to ski. He already has cut his hours to three days a week at the medical center, and he plans to retire in September unless his services are needed to treat COVID-19 patients.
McCahill has counted 10 or 11 doctors in Lake Placid, Saranac Lake and Keene who have recently hung up their stethoscopes or plan to do so soon.
The Adirondack Foundation is working to secure doctors for the park by cultivating homegrown talent. Since, 2002, the philanthropic organization has awarded 15 grants of $10,000 to students from the Adirondacks who go to medical school—in hopes that the recipients will come back to underserved communities. Adirondack Health’s chief medical officer, Darci Beiras, is a past recipient.
Foundation President and CEO Cali Brooks, of Lake Placid, has experienced the need firsthand. When her family’s doctors—Dorothy and Jay Federman—retired from Medical Associates of Saranac Lake, it took a year to be seen by a new doctor for a routine physical. Meantime, she said, physician assistants and nurses saw them.
Some 870 physicians serve seven counties with large footprints in the Adirondack Park, according to New York State licensing figures. But a large share of those work in the major communities outside the park in Clinton, Franklin, St. Lawrence and Warren counties. The 130,000 Adirondack residents must line up for a few dozen of them or travel outside.
Areas far from city hospitals have fewer options. Hamilton County, entirely within the blue line, has five doctors—just one of them a primary care physician.
Essex County, also entirely within the park (and McCahill’s home), has 16 primary care physicians for nearly 40,000 people.
It worries McCahill because of the way medicine has changed over the years. Primary care doesn’t pay fabulously, so fewer doctors go into the field because the salary won’t be enough to pay off student loans—as high as $300,000 for today’s new doctors. At the same time, doctors who depend on Medicare and Medicaid reimbursement often struggle, especially doctors in private practice, McCahill said.
For example, McCahill noted that a quick, simple procedure to remove skin cancer brings in three times the money of a lengthy appointment he might have with a senior citizen who has diabetes and congestive heart failure.
The changes have resulted in fewer physicians in the Adirondacks, McCahill said. He remembers several private practices with four or five doctors when he was younger. Now, there are fewer. Adirondack Internal Medicine and Pediatrics, a private practice established in 1976, is merging with Hudson Headwaters Health Network, a nonprofit model founded in 1975. Hudson Headwaters has 19 locations, most within the park.
Dan Larson, until 2018 the chief medical officer at Hudson Headwaters, did his residency with McCahill. He too has a cross-country skiing trail in his backyard. Larson, now 68, knew going into medical school he wanted to be a family doctor, and he chose Albany Medical School because of its proximity to the Adirondack Park. While a student, Larson rode the free shuttle from campus to the Northway and thumbed a ride into the wilderness.
He spent the first eight years of his career working at Yale University, where he had gone to undergraduate school. But every summer between 1981 and 1987 he spent a month working for Hudson Headwaters. He joined the staff full-time in 1988 and spent 30 years with the network. One of his primary jobs was to recruit doctors.
Because Hudson Headwaters is a nonprofit, Larson had access to resources other practices did not—and the ability to help newly minted doctors with their student loans.
“We could never promise it, but we could say it was likely, and if the state program didn’t come through, we could back it up with a guarantee we could help with 50% of the repayment,” Larson said. “The vast majority of our successful recruits had connections to the park, either vacations or family second homes, having gone to camp here.”
Almost everyone was an outdoorsperson.
And for doctors who wanted (or whose spouses wanted) a more suburban setting, Hudson Headwaters could offer Queensbury, where Larson lives and raised his family, or Glens Falls—both outside of the park.
Dan Way was another doctor who felt a calling to practice primary care. He wanted to live and work in Glens Falls, where he was born, and fantasized about working in the park. He finished his residency in 1980 and joined Hudson Headwaters in 1981. He saw patients in the office or when they were admitted to Glens Falls Hospital, and he made house calls, usually because a patient he treated in the office had become homebound.
“One of the most enjoyable parts of my job was the home visits 150 miles away,” Way said. “I’d take the whole day doing it. You learn so much more from a patient in their homes, but it wasn’t cost-effective. I did it because I wanted to, and I was allowed to.”
Way retired in 2017, but he is optimistic the medical needs of the people living in the Adirondack Park will be met—not necessarily always by doctors. Physician assistants and nurse practitioners can do everything an MD can do, Way said, but their education costs less and their salaries are lower. Their presence is vital while the compensation gap exists between primary care doctors and specialists.
And there is still the allure of the park itself; its wilderness and mountains, streams and lifestyle like none other.
Hudson Headwaters is partnering with the University of Vermont, whose medical students do a rotation there.
“They’re grooming future primary care physicians (that) we hope will come back,” Way said.